European Society of Cardiology/European Society of Hypertension versus the American College of Cardiology/American Heart Association guidelines on the cut-off values for early hypertension: a microvascular perspective.

The aim of this study was to investigate retinal and peripheral microvascular function in asymptomatic individuals that fall into different BP groups when using either the ESC/ESH or the ACC/AHA guidelines. Retinal and peripheral microvascular function was assessed in 358 participants by means of dynamic retinal vessel analysis and digital thermal monitoring, respectively. Blood pressure and lipid panel were also evaluated. Retinal vascular function measured in all groups belonging to the ACC/ASH classifications were within the normal values for age-matched normal population. Individuals classed as grade 1 hypertension according to the ESC/ESH guidelines, however, exhibited a significantly decreased artery baseline (p = 0.0004) and MC (p = 0.040), higher slopeAD (p = 0.0018) and decreased vein MC (p = 0.0446) compared to age matched normal individuals. In addition, they also had significant lower artery baseline, artery BDF, MD and MC than individuals classed as stage 1 hypertension based on the ACC/ASH guidelines (p = 0.00022, p = 0.0179, p = 0.0409 and p = 0.0329 respectively). Peripheral vascular reactivity (aTR) was lower in ESC /ESH grade I compared to those graded ACC/ASH stage I hypertension (p = 0.0122). The conclusion of this study is that microvascular dysfunctions is present at multiple levels only in individuals with ESC/ESH grade 1 hypertension. This observation could be important when deciding personalised care in individuals with early hypertensive changes.

Abnormal retinal vascular function and lipid levels in a sample of healthy UK South Asians.

BACKGROUND/AIMS: To investigate ethnic differences in retinal vascular function and their relationship to traditional risk indicators for cardiovascular disease (CVD). METHODS: A total of 90 normoglycaemic subjects (45 South Asian (SA) and 45 age- and gender-matched white Europeans (WEs)) were recruited for the present study. Retinal vessel reactivity to flickering light was assessed by means of the dynamic retinal vessel analyser according to a modified protocol. Fasting plasma glucose, triglycerides (TG), total, LDL and HDL cholesterol were also measured in all individuals. RESULTS: SA individuals showed higher fasting triglyceride (p=0.001) and lower HDL levels (p=0.007), leading to a higher TG:HDL-C ratio (p=0.001) than age-matched WE subjects. Additionally, in SAs, the retinal arterial reaction time in response to flicker stimulation was significantly longer in the last flicker cycle than in the WEs (p=0.039), and this change correlated positively with measured plasma TG levels (r=0.60; p=0.01). No such relationship was observed in the WEs (p>0.05). CONCLUSION: Even in the absence of overt vascular disease, in otherwise healthy SAs there are potential signs of retinal vascular function impairment that correlates with established plasma markers for CVD risk.

First-line therapy with latanoprost 0.005% results in improved ocular circulation in newly diagnosed primary open-angle glaucoma patients: a prospective, 6-month, open-label study.

PURPOSE: To evaluate the effect of latanoprost 0.005% on the optic nerve head (ONH) and retinal circulation of newly diagnosed and previously untreated primary open-angle glaucoma (POAG) patients. METHODS: Twenty-two newly diagnosed and previously untreated POAG patients (mean age+/-SD: 68.38+/-11.92 years) were included in this longitudinal open-label study. Patients were treated with latanoprost 0.005% once a day. Intraocular pressure (IOP), systemic blood pressure (BP), mean ocular perfusion pressure (MOPP), and ocular perfusion parameters 'volume', 'velocity', and 'flow' measured at the optic nerve head (ONH) and retina by means of Heidelberg Retina Flowmeter system were evaluated during a 6-month follow-up period. RESULTS: Treatment with latanoprost 0.005% resulted in a significant decrease in IOP (P<0.0001) and increase in MOPP (P<0.0001). After correcting for changes in MOPP, the blood velocity measured at the ONH level was significantly higher after 6 months of treatment than at baseline (P=0.0310). In addition, blood volume and flow measured at the peripapillary retina level improved after 3 and 6 months of treatment (P=0.0170; P=0.0260, and P=0.0170; P=0.0240 respectively). CONCLUSION: Previously untreated POAG patients exhibit reduced IOP, increased MOPP and improved ocular perfusion at the ONH and retina levels when treated with Latanoprost 0.005%. These effects could be beneficial for glaucoma patients suffering from ocular vascular dysregulation.

Beneficial effects of small-incision cataract surgery in patients demonstrating reduced ocular blood flow characteristics.

PURPOSE: To investigate intraocular pressure (IOP) and ocular haemodynamics following small incision cataract surgery. METHODS: Systemic and ocular haemodynamics, and IOP, were measured pre-operatively and 1 month post-operatively, in 25 eyes of 25 patients (mean age 72.6+/-7.9 years) scheduled for small incision cataract surgery and intraocular lens implantation; these values were compared to an untreated age-matched healthy group (n=25, mean age 72.3+/-5.0 years). For each eye, the Ocular Blood Flow Analyser (OBFA, Paradigm Inc., UT, USA) was used to obtain measurements of IOP, pulsatile ocular blood flow (POBF), pulse volume (PV), ocular pulse amplitude (PA), and pulse rate (PR). Systemic blood pressure measurements were obtained at each visit. Pre- and post-operative values for the cataract group were compared using repeated measures analysis of variance, and compared to the normal group using analysis of variance. RESULTS: Pre-operatively, IOP was significantly higher in the cataract group compared to the age-matched normal control group (P<0.001). Cataract surgery resulted in a significant 16.7% reduction in IOP (P=0.001). Consequently, the post-operative IOP in the cataract group was similar to that of the normal group (P>0.05). Both pre- and post-operative POBF and PV values for the cataract group were significantly lower than for the normal age-matched group (P<0.0125). Small incision cataract surgery led to an 8.3% post-operative increase in POBF (P=0.0118) and 15.5% increase in PV (P<0.001). No changes in PA or PR were evident. CONCLUSION: These data suggest that cataract patients exhibit higher IOP and reduced ocular perfusion characteristics compared to an age-matched normal healthy group. Following cataract surgery, IOP reduced and ocular pulsatility improved.

Corneal pachymetry in normal and keratoconic eyes: Orbscan II versus ultrasound.

PURPOSE: To compare corneal thickness measurements using Orbscan II (OII) and ultrasonic (US) pachymetry in normal and in keratoconic eyes. SETTING: Eye Department, Heartlands and Solihull NHS Trust, Birmingham, United Kingdom. METHODS: Central corneal thickness (CCT) was measured by means of OII and US pachymetry in 1 eye of 72 normal subjects and 36 keratoconus patients. The apical corneal thickness (ACT) in keratoconus patients was also evaluated using each method. The mean of the difference, standard deviation (SD), and 95% limits of agreement (LoA = mean +/- 2 SD), with and without applying the default linear correction factor (LCF), were determined for each sample. The Student t test was used to identify significant differences between methods, and the correlation between methods was determined using the Pearson bivariate correlation. Bland-Altman analysis was performed to confirm that the results of the 2 instruments were clinically comparable. RESULTS: In normal eyes, the mean difference (+/- 95% LoA) in CCT was 1.04 microm +/- 68.52 (SD) (P>.05; r = 0.71) when the LCF was used and 46.73 +/- 75.40 microm (P =.0001; r = 0.71) without the LCF. In keratoconus patients, the mean difference (+/- 95% LoA) in CCT between methods was 42.46 +/- 66.56 microm (P<.0001: r = 0.85) with the LCF, and 2.51 +/- 73.00 microm (P>.05: r = 0.85) without the LCF. The mean difference (+/- 95% LoA) in ACT for this group was 49.24 +/- 60.88 microm (P<.0001: r = 0.89) with the LCF and 12.71 +/- 68.14 microm (P =.0077; r = 0.89) when the LCF was not used. CONCLUSIONS: This study suggests that OII and US pachymetry provide similar readings for CCT in normal subjects when an LCF is used. In keratoconus patients, OII provides a valid clinical tool for the noninvasive assessment of CCT when the LCF is not applied.

Contrast sensitivity improves after brimonidine therapy in primary open angle glaucoma: a case for neuroprotection.

AIMS: To determine the visual outcome following initiation of brimonidine therapy in glaucoma. METHODS: 16 newly diagnosed previously untreated glaucoma patients were randomly assigned to either timolol 0.5% or brimonidine 0.2%. Visual acuity, contrast sensitivity (CS), visual fields, intraocular pressure (IOP), blood pressure, and heart rate were evaluated at baseline and after 3 months. RESULTS: IOP reduction was similar for both groups (p<0.05). Brimonidine improved CS; in the right eye at 6 and 12 cpd (p=0.043, p=0.017); in the left eye at 3 and 12 cpd (p=0.044, p=0.046). Timolol reduced CS at 18 cpd in the right eye (p=0.041). There was no change in any other measured parameters. CONCLUSION: Glaucoma patients exhibit improved CS on initiation of brimonidine therapy.

Retrobulbar blood flow in glaucoma patients with nocturnal over-dipping in systemic blood pressure.

PURPOSE: To evaluate the relationship between the circadian blood pressure rhythm and the retrobulbar blood flow in glaucoma patients. DESIGN: Cross-sectional study. METHODS: Circadian blood pressure measurements and color Doppler imaging (CDI) in the ophthalmic artery as well as the central retinal artery of one randomly selected eye were obtained in 193 primary open-angle glaucoma patients. CDI parameters were compared by means of analysis of covariance between patients with a nocturnal decrease in mean systemic blood pressure (MBP) below 20% of the average daytime MBP (over-dippers), patients with a decrease between 10% to 20% (dippers), and patients with a decrease of less than 10% (nondippers), using age, intraocular pressure (IOP), and MBP during color Doppler measurement as covariates. RESULTS: An analysis of covariance disclosed, after correcting for age, IOP, and MBP during color Doppler imaging, a significantly lower EDV (P =.0096) and a significantly higher RI (P =.033) in the central artery of over-dipping glaucoma patients compared with nondippers or dippers. This effect seemed independent of the use of vasoactive drugs . CONCLUSIONS: Glaucoma patients with a marked drop in nocturnal systemic blood pressure seem to have altered retrobulbar blood flow parameters, suggesting that an abnormal systemic blood pressure profile may be the manifestation of some kind of systemic vascular dysregulation relevant for the ocular circulation.

The influence of sex difference in measurements with the Langham Ocular Blood Flow System.

PURPOSE: To assess sex difference and parameters possibly accounting for such a difference in healthy subjects evaluated by means of the Langham Ocular Blood Flow (OBF) System. METHODS: Pulse amplitude of intraocular pressure (IOP) and pulsatile ocular blood flow (POBF) as measured with the Langham OBF System were assessed in 86 healthy men and 69 healthy women. RESULTS: Compared to men, women showed higher POBF (mean +/- SD: 722.6 +/- 152.8 versus 647.8 +/- 164.9 microL/min; P =.0056) and pulse amplitude (mean +/- SD: 2.3 +/- 0.7 versus 2.0 +/- 0.6 mm Hg; P =.0043) values. Sex difference was still significant after correcting for age, refraction, blood pressure, IOP, and pulse rate. Pulse amplitude correlated negatively with pulse rate, and POBF correlated negatively with IOP. Women had higher readings in pulse amplitude and POBF, even after correcting for age, refraction, IOP, blood pressure, and pulse rate. CONCLUSIONS: While using the Langham OBF System, one needs to be aware of sex difference that is independent of other hemodynamic parameters. How the observed difference in POBF is related to ocular blood flow, and how it might influence the preponderance of various ocular diseases in men or women remains to be clarified.

Effect of timolol on anterior optic nerve blood flow in patients with primary open-angle glaucoma as assessed by the Heidelberg retina flowmeter.

PURPOSE: To evaluate the effect of 0.5% timolol maleate on the capillary circulation of the anterior optic nerve head in patients with primary open-angle glaucoma and to compare the results with those obtained in a healthy control group. PATIENTS AND METHODS: Twelve patients with nonprogressive glaucoma and 12 age- and sex-matched healthy volunteers were included in this prospective study. Optic nerve head perfusion was examined by the Heidelberg Retina Flowmeter (HRF) in both groups. A 3-week washout period preceded the baseline measurement in the glaucoma group, and ONH blood flow was assessed again after 3 weeks of bilateral topical timolol treatment and 2 hours after timolol application. RESULTS: Intraocular pressure decreased significantly with timolol (P < 0.001). The HRF flow values for patients with glaucoma were comparable to those for a control group at baseline (P = 0.25), 3 weeks after timolol therapy (P = 0.09), and 2 hours after timolol instillation (P = 0.15). The glaucoma group showed no statistically significant change in the HRF parameter flow as compared with baseline, either after 3 weeks of timolol treatment or 2 hours after timolol instillation (P = 0.40). The heart rate and arterial systolic and diastolic blood pressure values showed no alteration after timolol therapy. CONCLUSIONS: Patients with nonprogressive glaucoma seem not to have an altered optic nerve blood flow as assessed by the HRF, and timolol treatment does not seem to alter the latter blood flow parameter in such patients.

Relationship between ocular perfusion pressure and retrobulbar blood flow in patients with glaucoma with progressive damage.

PURPOSE: To evaluate the relationship between ocular perfusion pressure and color Doppler measurements in patients with glaucoma. MATERIALS AND METHODS: Twenty patients with primary open-angle glaucoma with visual field deterioration in spite of an intraocular pressure lowered below 21 mm Hg, 20 age-matched patients with glaucoma with stable visual fields, and 20 age-matched healthy controls were recruited. After a 20-minute rest in a supine position, intraocular pressure and color Doppler measurements parameters of the ophthalmic artery and the central retinal artery were obtained. Correlations between mean ocular perfusion pressure and color Doppler measurements parameters were determined. RESULTS: Patients with glaucoma showed a higher intraocular pressure (P <.0008) and a lower mean ocular perfusion pressure (P <.0045) compared with healthy subjects. Patients with deteriorating glaucoma showed a lower mean blood pressure (P =.033) and a lower end diastolic velocity in the central retinal artery (P =.0093) compared with normals. Mean ocular perfusion pressure correlated positively with end diastolic velocity in the ophthalmic artery (R = 0.66, P =.002) and central retinal artery (R = 0.74, P <.0001) and negatively with resistivity index in the ophthalmic artery (R = -0.70, P =.001) and central retinal artery (R = -0.62, P =.003) in patients with deteriorating glaucoma. Such correlations did not occur in patients with glaucoma with stable visual fields or in normal subjects. The correlations were statistically significantly different between the study groups (parallelism of regression lines in an analysis of covariance model) for end diastolic velocity (P =.001) and resistivity index (P =.0001) in the ophthalmic artery, as well as for end diastolic velocity (P =.0009) and resistivity index (P =. 001) in the central retinal artery. CONCLUSIONS: The present findings suggest that alterations in ocular blood flow regulation may contribute to the progression in glaucomatous damage.

Interocular differences in optic disc topographic parameters in normal subjects.

PURPOSE: To test the interocular differences in optic disc topography in normal subjects by means of confocal scanning laser ophthalmoscopy. METHODS: Topographic measurements of the optic disc were evaluated by means of confocal scanning laser ophthalmoscopy (Heidelberg Retina Tomograph) in 314 eyes of 157 healthy volunteers. The examination was started randomly either with the right eye or the left eye. Differences between right and left eyes in disc area, cup area, cup volume, cup/disc area ratio, rim area, rim volume, maximum cup depth, cup shape measure, retinal nerve fiber layer thickness, and retinal nerve fiber cross section area for 360 degrees and for the temporal and nasal regions of the optic nerve head were evaluated by means of Student t-test. The same parameters were assessed in a subgroup of 80 elderly (age> 50 years) healthy subjects. Holm's sequentially rejective method was used for significance correction of multiple comparisons. RESULTS: Significant interocular differences in the average retinal nerve fiber layer thickness (p = 0.0010) and retinal nerve fiber layer cross section area (p = 0.0036) were found, with the right eye showing, on the average, lower values. The left eye showed a larger retinal nerve fiber layer thickness in 94 subjects (59.87%) and a larger retinal nerve fiber cross section area in 101 subjects (64. 33%). In the temporal optic disc area there were no statistically significant differences in topometric data (p> 0.05). In the nasal area, significant interocular differences in the retinal nerve fiber layer thickness (p = 0.0002) and retinal nerve fiber layer cross section area (p = 0.0003) were found. Similar results were found when the group of subjects older than 50 years was considered. CONCLUSIONS: This study demonstrates systematic interocular differences in optic disc topometric data. Such a finding, be it due to methodological or biological reasons, should be taken in consideration in clinical trials.

[Open angle glaucoma. Identification of vascular risk factors]. / Glaucomul primitiv cu unghi deschis identificarea factorilor de risc vasculari.

Although the clinical picture of primary open-angle glaucoma (POAG) is well described, the exact mechanism leading to this specific type of damage is still under investigation. Among the vascular risk factors, hypotension and vasospasm seem to have an important role in the pathogenesis of this disease. This review presents the importance of hypotension and vasospasm in the pathogenesis of POAG and an inventary of the principal methods for their detection.

[Actualities in retinoblastoma's treatment]. / Actualitati în tratamentul retinoblastomului.

The management of retinoblastoma should be undertaken by multidisciplinary health care team. Ophthalmopediatrics and ocular oncologists have sought effective alternative methods for treating retinoblastoma. The management of retinoblastoma has been changed significant past few years. Recently, advances in understanding of retinoblastoma have led to trials of new treatment modalities aimed at decreasing morbidity and continuing excellent survival. This review tries to present the new and modern aspects in retinoblastoma therapy.

Is vascular regulation in the central retinal artery altered in persons with vasospasm?

OBJECTIVE: To assess the relation between ocular perfusion pressure and blood flow velocity in the central retinal artery in patients with acral vasospasm. SUBJECTS AND METHODS: Eighteen otherwise healthy subjects with acral vascular dysregulation, as demonstrated by nail-fold capillaroscopy, and 18 age- and sex-matched healthy volunteers without vasospasm were recruited. After subjects had rested for 20 minutes in a supine position, intraocular pressure and blood flow velocity in the central retinal artery were determined by applanation tonometry and color Doppler imaging, respectively. The peak systolic velocity, end-diastolic velocity, and resistivity index were assessed. Correlations between the mean ocular perfusion pressure (2/3 x [2/3 x diastolic blood pressure + 1/3 x systolic blood pressure] - intraocular pressure) and blood flow velocities in the central retinal artery were determined by the Pearson linear correlation factor. The Student t test was used to evaluate differences between controls and subjects with vasospasm. RESULTS: The mean +/- SD ocular perfusion pressure was 42.0 +/- 7.4 mm Hg in the group with vasospasm and 47.1 +/- 6.5 mm Hg in the control group (P= .04). In the subjects with vasospasm, the peak systolic and end-diastolic velocities and the resistivity index of the central retinal artery correlated significantly with the mean ocular perfusion pressure (R = 0.49, P = .04 P = .01; and R = -0.67, P = .002, respectively). Such correlations were not found in the control group. CONCLUSIONS: An altered blood flow regulation is suggested in the ocular circulation of patients with acral vasospasm.